Clinical Mental Health Counseling

Elements of Effective Practice

J. Scott Young, Craig S. Cashwell

• Publisher: SAGE Publications, Inc
• Year: 2016
• ISBN:
  9781506305653
• Edition: 1
• Topic: Education
• Subtopic: Education Counseling

Referencing the 2016 CACREP standards, Clinical Mental Health Counseling: Elements of Effective Practice combines solid foundational information with practical application for a realistic introduction to work in community mental health settings. Top experts in the field cover emerging models for clinical interventions as they explore cutting-edge approaches to CMH counseling. With case studies integrated throughout, students will be well prepared to move into practicum and internship courses as well as field-based settings. "An instant classic. Young and Cashwell have assembled a stellar group of counselor education authors and produced an outstanding, comprehensive, and easy-to-read text that clearly articulates and elevates the discipline of clinical mental health counseling. This book covers everything a CMHC needs to hit the ground running in clinical practice!" — Bradley T. Erford, Loyola University Maryland, Past President of the American Counseling Association

1 History and Evolution of Clinical Mental Health Counseling

Kerrie K. Fuenfhausen

Scott Young

Craig Cashwell

Muthoni Musangali

Learning Goals

Upon completion of this chapter, you will be able to do the following:

1. Define the practice of clinical mental health (CMH) counseling and the unique elements of this counseling specialty
2. Understand the history and development of CMH counseling as a specialty practice
3. Describe the foundational principles and philosophy of the CMH specialty
4. Understand the range of services provided by CMH counselors
5. Identify the training, certification, and licensure required to practice as a CMH counselor
6. Communicate effectively about models of CMH counseling

CMH counseling is a vibrant and dynamic field of practice that affords counselors rich potential to impact the lives of clients. The Bureau of Labor Statistics indicated that there were over 128,000 CMH counselors practicing in the United States in May 2015 (Bureau of Labor Statistics, 2016). Current estimations suggest significant growth in the number of CMH counselors needed, with a projected growth rate of 24%, which is much higher than average for most professions. The anticipated growth in the field provides job security and rich opportunities for CMH counselors into the future. In 2012, the earning potential for CMH counselors ranged from $32,000 to $48,000 in the top industries in which these counselors worked, with a median income of about $40,000 (Bureau of Labor Statistics, 2013). This range primarily applies to work within mental health agencies, and the earning potential within private practice is significantly higher. There is good potential for employment and meaningful work as a CMH counselor, which is shaped by the unfortunate reality that there are many individuals who suffer from mental disorders and are in need of treatment to cope with the debilitating effects of mental illness as well as the normal developmental challenges and struggles of life. To understand how the field of CMH counseling fits within the scope of the helping professions and the field of counseling specifically, it is helpful to begin with an overview of the counseling field and the foundational orientations upon which the field is built.

Foundational Principles of Counseling

The mental health field includes different types of helping professionals: counselors, social workers, psychologists, psychiatrists, mental health technicians, and marriage and family therapists, to name a few. Each of these professions has its own training standards, licensure and certification requirements, ethical codes, and standards of practice, as well as organizations that serve to define the profession and support practitioners. Perhaps more importantly, however, each field has a unique professional identity, a shared philosophy of helping that distinguishes it from the other mental health professions. In the profession of counseling, that identity is characterized by the following:

1. A wellness model of mental health
2. A developmental perspective
3. A focus on prevention and early intervention
4. The empowerment of clients (Remley & Herlihy, 2010)
5. An ongoing commitment to multicultural considerations

These principles are embodied in the definition approved by the ACA Governing Council and posted on the ACA website (www.counseling.org): “Counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals.”

The designation of counseling as a profession, of which CMH counseling is a subspecialty, is important because such a status gives legitimacy to the work and makes it a specific vocation in which not just anyone can claim membership. Technically, for an occupation to qualify as a profession, a definitional set of criteria must be met (Greenwood, 1962; Gross, 1958). When these criteria are considered within the context of professional counseling, it quickly becomes evident that counseling indeed meets the criteria of a unique profession.

1. A specialized body of knowledge. Counseling is clearly a field that produces a unique body of knowledge. This is evident from the fact that there are scientific journals that addresses the broad continuum of work that counselors do (e.g., The Journal of Counseling and Development).
2. Systematic theory. A theory is an explanation of a certain set of observed phenomenon in terms of a system of constructs or laws that relate to one another. Counseling uses a range of theories that inform practice, including traditional theories of individual psychology (such as psychoanalytic, behavioral, and existential humanistic models) and theories of group interactions (such as family systems and group theory). More recent are emerging models of the most effective treatment of specific mental health concerns, such as trauma focused cognitive behavioral therapy to treat the effects of trauma.
3. Special relationship between practitioner and client. Legal statutes and ethical standards make it clear that the work of CMH counselors exists within a specialized professional relationship that provides protection to the client. Accordingly, licensed counselors work under a set of unique legal and ethical responsibilities that are outlined both by licensure bodies with individual states and by professional association (e.g., The American Counseling Association).
4. Societal approval. That counseling is recognized broadly as a profession is evidenced by state licensure, national credentialing, accreditation standards, and legal precedence. Furthermore, the fact that the services of counselors are reimbursed by both public and private payers makes it clear that there is broad social acceptance of the important role that counselors play in society. See Table 1.1 for an overview of counselor national certification and licensure.
5. Standards for admitting and policing practitioners. Individuals can join the counseling profession only after completing a minimum of a master’s degree in counseling. Additionally, licensure by a state licensing board is required for independent practice. Each of the 50 U.S. states has licensure laws regulating the title and scope of practice of professional counselors. Typically, licensure laws govern title (who may use a title such as professional counselor) and practice (what a professional counselor can do). Once a counseling professional begins practicing, he or she can be charged for ethical violations of professional standards and be sanctioned by or dismissed from professional societies or from practice by licensure boards.
6. Code of ethics. A unique code of ethics guides the decision making and professional practice of its members. At a minimum, CMH counselors operate under the ethical standards used by the appropriate state licensing board. If the CMH counselor holds additional professional memberships (e.g., American Counseling Association [ACA] or American Mental Health Counselors Association [AMHCA]) or credentials (e.g., National Certified Counselor), he or she is subject to additional ethical standards and codes of practice.
7. Professional organizations and similar evidence of a professional culture. Many counselors belong to professional organizations such as the ACA and AMHCA. Additionally, many counselors are members of Chi Sigma Iota, the international counseling academic and professional honor society. CMH counselors also join specialty groups, such as the Society for the Study of Trauma and Dissociation, or attain specialty credentials, such as certified sex addiction therapist, that focus on more discrete populations and issues.

Table 1.1

Source: Reprinted by permission of the National Board for Certified Counselors and Affiliates, 3 Terrace Way, Greensboro, NC 27403. © 2013 All Rights Reserved.

Table 1.2 lists the divisions of the American Counseling Association and related journals.

Table 1.2

Wellness Model of Mental Health

All counselors, regardless of specialty, operate from the perspective that the goal of counseling is to promote general wellness, rather than to focus solely on curing an illness or fixing a problem. The wellness model of mental health emphasizes the importance of helping clients work toward optimal mental and emotional health. The wellness perspective is an alternative to the medical or illness model used by most other helping professions, which approaches client concerns by isolating the problem, diagnosing an illness, and treating the symptoms in an attempt to cure the problem and return the client to his or her prior level of functioning. From this perspective, health is equated with the absence of problems or symptoms. This perspective is also referred to as the deficit model, because it is focused on what is wrong or lacking in an individual.

Professional counselors, on the other hand, help clients focus on their strengths and how those strengths can assist them in moving toward optimal well-being of body, mind, and spirit. This perspective emphasizes a holistic view of wellness across many areas of life, including the physical, emotional, mental, spiritual, relational, vocational, financial, and sexual realms. Based on an understanding that each of these areas can affect one another, as well as one’s overall wellness, counselors support clients in evaluating which areas may need attention in order to improve one’s general health and well-being (Myers, Sweeney, & Witmer, 2000). For example, a client may be struggling with depression or anxiety (emotional/psychological) and job-related stress (vocational), but through a strength-based assessment of wellness, the counselor discovers that the client has a passion for running (physical) and a meaningful spiritual practice. The counselor would help the client to draw on these physical and spiritual strengths and resourc...